Comparison of pain and efficacy between large-bore and small-bore chest tube drainage for malignant pleural effusion in Songklanagarind Hospital: A randomized controlled trial.

Abstract

e19608 Background: Malignant pleural effusion is one of the most common presenting symptoms in lung cancer. There has been no large RCT comparing large-bore and small-bore chest tubes in terms of pain and efficacy of management. Methods: A randomized controlled trial was conducted in 2011. Patients with malignant pleural effusion were randomly allocated to receive either a large-bore or small-bore chest tube. The primary objective was to compare pain using the Numeric Rating Scale. Other objectives included the efficacy of the drainage and pleurodesis and any complications were recorded. Results: Each arm comprised 21 patients. Median age was 61.2 years. Thirty-eight patients (90.5%) had adenocarcinoma; 14(33.3%) had received systemic chemotherapy. Pain score did not differ significantly between the groups from the time of tube insertion to removal. However, pain rose from day 4 until day 9 in the small-bore group. The proportion of patients requiring a second chest tube was higher in the small-bore group (small-bore = 7, 33.3 %; large-bore = 1, 4.8%; p 0.052). Complications were higher in the small-bore group. Five patients were complicated by tube occlusion which occurred only in the small-bore group (23.8 %, p 0.048). Times from tube insertion to lung expansion, to pleurodesis and to chest tube removal did not differ significantly between groups. Pleurodesis was effective in 70-80 % in both groups at the 28-day follow-up. Conclusions: No differences between large-bore and small-bore chest tubes were seen in pain, efficacy of drainage or success of pleurodesis. However, small-bore chest tubes had a higher rate of occlusion and more frequently required additional tube insertion.